Enhanced school-based vision screening in Kumasi, Ghana: a pilot study to assess feasibility

Childhood vision loss is a public health concern in Ghana, where access to eye care is limited. This prospective cohort pilot study was conducted to examine the feasibility of an enhanced, school-based vision screening protocol among children enrolled in a private and public school in Kumasi, Ghana.

In November-December 2024, optometrists used an enhanced vision screening protocol to screen for eye disorders. Children were aged 4-22 in Primary 1 to Junior High School (JHS) 3 classrooms. Children identified with significant suspected eye disorders, as defined by established criteria, were referred off-site to an eye clinic for a comprehensive eye examination. Outcome measures included participation in vision screening, prevalence of suspected eye disorders, referral adherence, and program acceptability. Referral adherence was assessed using parent or guardian questionnaires, reports from referring optometrists, and interviewer-led surveys with children. Acceptability was assessed through focus groups with teachers, school administrators, and parents/guardians. Descriptive statistics were used to summarize participant characteristics and screening outcomes, and Pearson's chi-square and two-sample t tests were used for bivariate comparisons by school type.

Out of 2,150 children attending both schools, 1,152 (53.6%) consented to being screened and completed screening. Complete data for 1,123 (97.5%) children was analyzed; 437 (38.9%) attended public and 686 (61.1%) private school. The average age of children screened was 10.2 (±2.6) years. The prevalence of suspected eye disorders was 34.0% (n = 382). Referral adherence was assessed for 299 children, of which 98 (32.8%) adhered to the referral. Teachers, school principals, and parents/guardians found the screening program acceptable.

Half of the eligible children participated in the school-based vision screening program, a third were identified with untreated eye disorders, a third adhered to referral and the program was acceptable to key stakeholders. Enhanced school-based vision screening could be a feasible strategy to identify untreated eye disorders among school children in Kumasi, Ghana, however strategies to improve participation, and referral adherence are needed.